Change in Health

Applied for Housebound and received benefit late last year for my FIL. He recently had a stroke and will require rehab and may require extended care. We are still uncertain whether he will be able to manage with home care or if a nursing home will be needed. Does anyone have insights on if additional aid is available and what steps/forms are needed?

I'm sorry about your FIL's stroke. I hope he will make some progress in rehab.

Others (especially Kaylin) will hopefully weigh in, but my thoughts:

--If he is already receiving Housebound Pension, I wouldn't think a new full application for the Aid & Attendance benefit (A&A) would be necessary(?). If I'm correct, then you would only need to file a Statement in Support of Claim (VA Form-21-4138) informing the VA of your FIL's changed circumstances and requesting a review to see if he can be bumped up to A&A......Kaylin--is this your take? If not, please correct.

--Any mention of nursing homes gives rise to a consideration of Medicaid. If this is an option for your FIL, remember he cannot receive the full Housebound or A&A benefit if he is on Medicaid. I believe the A&A benefit drops to $90/mo and can only be used for the purchase of personal items; I'm not sure if it's the same amount for Housebound.

If he's already receiving Housebound pension you will just need to update the VA with a Statement in Support of Claim form 21-4138 that he requires more aid and is spending more money on care and therefore asking for an increase in the benefit amount. With this you would need to show supporting documents like bank statements that show the increase in care costs and a Nursing Home Status Statement form and Statement of Occupancy from the assisted living or nursing home. The Statement of Occupancy you will just ask the facility for. The Nursing Home Status Statement form and 21-4138 can be found on www.VeteranAid.org.

I'm sorry about your FIL's stroke. I hope he will make some progress in rehab.

Others (especially Kaylin) will hopefully weigh in, but my thoughts:

--If he is already receiving Housebound Pension, I wouldn't think a new full application for the Aid & Attendance benefit (A&A) would be necessary(?). If I'm correct, then you would only need to file a Statement in Support of Claim (VA Form-21-4138) informing the VA of your FIL's changed circumstances and requesting a review to see if he can be bumped up to A&A......Kaylin--is this your take? If not, please correct.

--Any mention of nursing homes gives rise to a consideration of Medicaid. If this is an option for your FIL, remember he cannot receive the full Housebound or A&A benefit if he is on Medicaid. I believe the A&A benefit drops to $90/mo and can only be used for the purchase of personal items; I'm not sure if it's the same amount for Housebound.

I'm sorry about your FIL's stroke. I hope he will make some progress in rehab.

Others (especially Kaylin) will hopefully weigh in, but my thoughts:

--If he is already receiving Housebound Pension, I wouldn't think a new full application for the Aid & Attendance benefit (A&A) would be necessary(?). If I'm correct, then you would only need to file a Statement in Support of Claim (VA Form-21-4138) informing the VA of your FIL's changed circumstances and requesting a review to see if he can be bumped up to A&A......Kaylin--is this your take? If not, please correct.

--Any mention of nursing homes gives rise to a consideration of Medicaid. If this is an option for your FIL, remember he cannot receive the full Housebound or A&A benefit if he is on Medicaid. I believe the A&A benefit drops to $90/mo and can only be used for the purchase of personal items; I'm not sure if it's the same amount for Housebound.

Hope that helps. Good luck to you and please keep us posted.

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Thank you. He currently has Medicare and supplemental. Wouldn't be eligible for Medicaid yet but it might come to that. We now know he will need rehab but uncertain beyond that except we suspect he will at a minimum need home care ongoing.

If he's already receiving Housebound pension you will just need to update the VA with a Statement in Support of Claim form 21-4138 that he requires more aid and is spending more money on care and therefore asking for an increase in the benefit amount. With this you would need to show supporting documents like bank statements that show the increase in care costs and a Nursing Home Status Statement form and Statement of Occupancy from the assisted living or nursing home. The Statement of Occupancy you will just ask the facility for. The Nursing Home Status Statement form and 21-4138 can be found on www.VeteranAid.org.

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Thank you. We expect his costs to increase because we feel he will need some form of home care following rehab. He also broke his ankle on leg opposite of stroke effects and it's expected to slow, long healing process.

Thank you both. At this point we believe the best option might be assisted living. My FIL is 94 and we expect he will need some type of care with daily activities. His wife is 92 and she won't be able to handle his needs. Ideally we would like to get them both into assisted living. If we could get the maximum benefit, it might be possible. I'm not sure who will make the determination or recommendations for assisted living for them to qualify for maximum benefits. Do we plan to move them to assisted living and then apply or will it require a medical statement from the rehabilitation facility that he should be in assisted living. Any insights into this situation will be appreciated.
Kind regards,
RJH

Thank you both. At this point we believe the best option might be assisted living. My FIL is 94 and we expect he will need some type of care with daily activities. His wife is 92 and she won't be able to handle his needs. Ideally we would like to get them both into assisted living. If we could get the maximum benefit, it might be possible. I'm not sure who will make the determination or recommendations for assisted living for them to qualify for maximum benefits. Do we plan to move them to assisted living and then apply or will it require a medical statement from the rehabilitation facility that he should be in assisted living. Any insights into this situation will be appreciated.
Kind regards,
RJH

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It is usually best to go ahead and move them into an ALF and then apply for the increased A&A benefit amount because then you'll have evidence showing their updated monthly care expenses.

Thank you both. At this point we believe the best option might be assisted living. My FIL is 94 and we expect he will need some type of care with daily activities. His wife is 92 and she won't be able to handle his needs. Ideally we would like to get them both into assisted living. If we could get the maximum benefit, it might be possible. I'm not sure who will make the determination or recommendations for assisted living for them to qualify for maximum benefits. Do we plan to move them to assisted living and then apply or will it require a medical statement from the rehabilitation facility that he should be in assisted living. Any insights into this situation will be appreciated.
Kind regards,
RJH

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RJH; first, condolences.
I wish I could give you more upbeat news but as you've probably already seen, you've entered a minefield with seemingly endless twists, turns, and detours along the way. We are just a few months ahead of you but our situations are quite similar so some of what we have learned might be of value to you.
My Mom (93) fell and broke femur in Jan. After surgery she went to rehab for two months hoping for complete recovery to the point where she could return to independent living. Prior to this fall, she had a similar one three years ago, had surgery, 6 weeks of rehab and returned home.
3 years older, that much more fragile, and it just isn't to be this time.
After 2 months the rehab facility informed us that Medicare was going to discontinue coverage because she had failed to progress and her condition was unlikely to improve. I think it might vary by state (this is NY) but here they are required to file weekly progress reports on which the insurance coverage is based.
We were given 48 hours notice of termination. Options at that point were: self-pay for rehab $15k/month, 24/7 home health aide coverage $18k/mo; or "Enhanced" Assisted Living $6-9k/mo. Medicare would continue to pay for PT on outpatient basis and rehab said if at home she would require 24/7 HHA coverage but Medicare would not pay for that or for Assisted Living.
VAA&A is about the only option for assisting living assistance. Medicaid (if qualify) for Skilled Nursing or Home but not assisted.
Enhanced AL is the obvious choice IF you can find a suitable facility with vacancy.
At least here, the Assisted Living facilities are strictly regulated and limited to what services they are allowed to provide by their licensing.
Some can perform things like toileting or assistance with dressing....some can't and won't accept folks that have those needs.
The facility we settled on charges "a la carte" for services in addition to basic room rent. X $/mo for showering, Y$/mo for toileting, etc.
My bride and I spent many hours visiting and interviewing almost 10 different AL facilities prior to finding a suitable one that had vacancy.
We are also dealing with my FIL (90) whose wife passed unexpectedly last Sept. He has type2, blind in one eye and walks with walker but very limited. MIL did everything (and I mean everything) for him so he's basically incapable of living on his own unattended.
We first brought in a HHA from an agency which came highly recommended. We've since retained the services of an aide privately and that is working out much better although that too is not without its "issues".
Any agency is only as good as the specific aide they send you and while our first one was a gem. She left though which apparently is quite common since they are underpaid and most will jump ship at the drop of a hat for a few bucks. Can't blame them but it makes it very difficult especially after the senior gets used to and likes the aide. When she left, the agency really dropped the ball. Initially not telling us that she had left ("her car broke down") or that they didn't have enough help to cover. Sent different aides each day IF they sent one at all.
Best of luck and if I can help in any way don't be afraid to ask.